Personalized Pain Management in Orthodontic Treatment: A Narrative Review of Biological, Psychological, and Clinical Determinants

Orthodontic pain is a frequent and clinically relevant experience during treatment, particularly after separator placement, bonding, archwire insertion, appliance activation, and elastic use. Although pain is often transient, it may negatively affect comfort, cooperation, diet, oral hygiene, satisfaction, and adherence. Orthodontic pain is not determined solely by mechanical tooth movement; it reflects a complex interaction between inflammatory tissue responses, individual pain sensitivity, psychological status, previous dental experiences, appliance type, and procedure-related factors. This narrative review summarizes the biological, psychological, and clinical determinants of orthodontic pain and discusses current pharmacological and nonpharmacological pain management strategies. Based on the available evidence, a proposed conceptual framework for personalized orthodontic pain management is presented. This framework stratifies patients into low-, moderate-, and high-risk profiles according to biological sensitivity, anxiety, pain expectation, treatment stage, and clinical complexity. Low-risk patients may require reassurance and basic instructions, whereas moderate- and high-risk patients may benefit from closer follow-up, individualized education, short-term analgesic planning, and selected adjunctive strategies. This framework should be interpreted as a conceptual model rather than a validated clinical prediction tool. Future prospective studies are needed to validate practical risk assessment instruments and individualized pain control protocols in orthodontic patients.